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Evaluation of Radiological Features as Predictive Markers for Pulmonary Hypertension

Kimmoi Wong Lama

Toshita Kumar


Nina Kohn

Rebecca Miller

Arunabh Talwar


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Kimmoi Wong Lama, Toshita Kumar, Purvesh Patel, Nina Kohn*, Rebecca Miller, Arunabh Talwar

Hofstra North Shore-LIJ School of Medicine, New Hyde Park, USA

*Feinstein institute of medical research

BACKGROUNDChest computed tomographic angiography (CTA) is often performed in the diagnostic evaluation of patients suspected of having pulmonary arterial hypertension (PAH). The purpose of this study was to assess the predictive value of pulmonary artery diameter (PAD), PAD/aorta diameter (PAD/AD) ratio and contrast medium reflux into the hepatic veins in diagnosing PAH (WHO group I).

METHODS: Patients referred for evaluation to our PAH center who received a chest CTA within 90 days of right heart catheterization (RHC) were reviewed retrospectively. CTA studies were independently reviewed by two physicians. PAD, AD and the presence or absence of reflux of contrast medium reflux into the hepatic veins were noted. PAH was defined as mean pulmonary artery pressure (mPAP)>25 mmHg and left ventricular end diastolic pressure (LVEDP) or pulmonary capillary wedge pressure (PCWP) < 18 mmHg by RHC. Data were analyzed using SAS(r) software, version 9, Cary, NC.

RESULTSThirty-six patients were included in the analysis. PAD/AD increased as the mPAP measured at cardiac catheterization increased [Spearman correlation coefficient 0.617; p<0.0001]. There was also a significant correlation between the PAD and mPAP [correlation coefficient 0.503; p <0.05].

Of the 36 patients, 6 patients had a reflux into the hepatic veins on the CTA. Pulmonary artery systolic pressure (PAS) measured during the cardiac catheterization was higher (median 94.5, interquartile range 44.0) in patients with evidence of reflux of dye in the hepatic veins than those without (median 61.0, IQR 27.0. [Mann-Whitney test, p<0.05]. Mean PA pressure was also higher (median 44.0, IQR 23.0 vs. 34.0, IQR 14.0), but this difference was not statistically significant.

CONCLUSIONS:  CTA provides a useful non invasive measure of predicting pulmonary artery pressure that may be used to screen patients for presence of pulmonary arterial hypertension. Evaluating PA diameter, PAD/AO ratio and reflux of dye in the hepatic vein on CTA can allow the radiologist to alert the pulmonologist to consider possibility of PH in the patients.